Care Following a Pull-Through Procedure for a Child with Hirschsprung Disease

Hi, my name is Olivia, and I'm a nurse with the division of Colorectal and pelvic reconstruction at Children's National Hospital. Today I'm going to talk to you about post-operative care following a pull-through procedure for a child with Hirschprung's disease. Hirschsprung's disease affects the part of the bowel also known as the large intestine or colon. It is when there are no nerve cells called ganglion cells in part of the intestines. Without these nerves, it is difficult for stool to pass through the colon and out of the anus. Children with Hirschpru's disease also have difficulty relaxing their anal sphincters, which makes it hard for them to stool. Hirschspring's disease is treated with surgery to remove the segment of colon that does not have ganglion cells. The good bowel that does have ganglion cells is then pulled down and connected to the rectum to help the child have more normal stooling. The goal of this video is to make you feel confident and comfortable caring for your child after they have had surgery to treat their Hirschprung's disease. To care for your child's surgical sites, you should not require any medical supplies. We want to keep the stitches on your child's bottom clean and dry. If your child had cuts on their belly, he or she will have white strips of tape called steri strips covering the cuts. This tape will fall off on its own in 7 to 14 days. Do not pull or remove the Steri-Strips, even if they start to look dirty or curl up on the ends. Leave them alone, and they will fall off when they are ready. Taking them off too soon can cause the skin to break open. If your child has an ostomy, you should go back to the care that you were doing before surgery. If your child is stooling or pooping from their anus or bottom, Please be sure to watch our skincare educational video, as your child will need special attention for their skin. After surgery, your child's stool pattern may change as they heal. Stools may be very loose and watery several times a day, to coming out very thick and not coming out very often. Your child may be prescribed MiraLax and Or Senna upon discharge to make sure they are stooling every day. This is also to help soften the stool so hard stool is not passing through your child's new anal opening. If your child is breastfed and stooling well, MiraLax and Oenna may not be started until they begin eating solids and their stool starts to thicken. If your child is stooling very often, and the surgeon expects that they will have a fast-moving colon, Then they may be prescribed a diet and medications to slow down your child's stools. Diet can play a major role in bowel management. Our laxative food list will help stool be softer and looser. Our constipating food list will help stool be thicker and harder. Please refer to our laxative and constipating diet list for more information. If you experience any of the following problems, please call. Call or email our team immediately. If your child has a fever of 101 °F or higher, if the incision or surgical cut has yellow or green liquid or drainage, if the site edges are pulling open, if the catheter comes out of your child, if your child is vomiting and isn't able to eat food or drink liquids, if your child is not stooling or stooling more than you were told they should, If your child is showing any signs of enterocolitis, if you were told to perform rectal irrigations on your child, please be sure to watch our video on irrigation, which can be found on our website. If you want more information, please visit the Colorectal Program's website. We have multiple videos and printed resources to help you care for your child. And don't forget, always check with your child's pediatrician or our medical team when caring for your child's medical needs.